Frequently Asked Questions

Who is EHS?

EHS Medical Group is a professional corporation owned by a group of physicians and organized as an independent physician association (IPA) in multiple markets to take managed care risk. More information on EHS is available here.

Five reasons why you should join EHS now!

  1. EHS is physician owned and physician driven
  2. Competitive compensation and rewards programs
  3. Market power and collective purchasing benefits
  4. Growth potential with access to managed care contracts
  5. Group purchasing power and deep discounts

Do I have to contract with EHS?

No. Contracting with EHS is strictly voluntary, but as stated earlier, independent physicians and providers do not have leverage when trying to negotiate with insurance companies.

Are there other IPAs in my area?

At this point we don’t know. All we know is that EHS has made the conscious decision to enter the market and assist independent physicians and providers by organizing a virtually integrated delivery system.

Can I keep my fee-for-service compensation?

Yes. EHS offers fee-for-service rates competitive to those you already receive by billing the state directly. In fact, if we do our jobs right in our negotiations with the health plans, we may be able to offer you higher rates than what you currently receive. We also offer other compensation models, including capitation, for those primary care physicians who have an interest in this method of payment.

Will I continue to be paid for my CHDP and vaccines if I join EHS?

If EHS negotiates with the health plans to be responsible for CHDP and you elect to be paid by EHS on a fee-for-service basis, then you will continue to be paid by EHS for CHDP services. If you elect to be paid by EHS on a capitated basis, then CHDP services will be considered part of the negotiation. Vaccines for Medi-Cal members are covered by the federal Vaccines for Children (VFC) program.

Which rural counties will EHS participate in?

EHS participates in 9 counties including Sacramento, Madera, Fresno, Kings, Tulare, Los Angeles, Orange, San Bernardino, Riverside and is expanding. EHS is reaching out and expanding its network to physicians and providers in each of the rural counties on the California target list of rural counties state’s target list.

Where can I learn more about EHS’s contract?

To learn more about the EHS contract, just provide us with your contact information in the form below.  You will be given access to download our contract after you fill out the form.

Will EHS accept claims electronically?

Yes. EHS providers can submit claims electronically through our secure, HIPAA-compliant web portal CONNECT. The central intelligence unit for our growing network,CONNECT provides comprehensive online practice and patient management by allowing health administrators and individual physicians to securely access, store and process information from anywhere, instantaneously. It offers a diverse menu of functions including authorizations, claims submissions and eligibility verification services. In addition, CONNECT supports CHECKBOOK, our online claims approval engine; DIRECT, our platform that allows medical directors to manage at-risk patients; and CONSULT, our eConsult chassis.

I signed my contract. When will my members transition to EHS?

There are two factors that determine when a primary care physician’s members will transition to EHS Medical Group. First, you must sign and return your EHS contract and provide us with your credentialing information. Second, EHS must have a contract with at least one of the HMOs awarded the Medi-Cal managed care bid for that county. Upon receipt of these items, the process of moving your members begins. After that, this process takes a minimum of 45 days, as the state and the HMO will both be required to notify the individual members of the change. Until members begin to present their new HMO ID cards listing EHS as the IPA, it’s best to verify eligibility on both the state’s and the HMO’s eligibility systems.

What if I signed a contract with EHS but a patient shows up with a different PCP name on their HMO ID card?

If you are an EHS PCP and a patient shows up with a different PCP name on their HMO ID card, you will not get paid by EHS if you see that patient. Tell the patient to go to the PCP indicated on their ID card to receive care. If the patient still wants to see you, they must call the HMO and specify that they want to transfer and choose you as their PCP. Please note that the transfer will not occur until the first day of the following month. For example, if the request is made on the 10th of March, the change will not be effective until the 1st of April. It also means that if you choose to see that member BEFORE the change is effective, you may not get paid for that visit. Specialists who contract with more than one IPA or HMO must refer to their contract with that IPA or HMO for instructions on how to handle referrals from that particular IPA or HMO.

I used to send all my claims directly to the state. With this new HMO thing, what services are EHS’s financial responsibility and what services are the HMO’s financial responsibility?

For the most part, professional services rendered in a physician office are the IPA’s financial responsibility. Most ancillary services (lab and x-ray) are also the IPA’s financial responsibility. Hospital and other inpatient services would be the HMO’s responsibility. Regardless of the HMO, EHS has regular meetings with all of its contracted HMOs and reviews all service areas that may fall into a gray zone.

I checked out your websites and like the tools you offer to physicians. How can I sign up for your CONNECT web portal and how can I get training?

Once you login, you can submit inquiries and questions through the system. By submitting your inquiries online, we can investigate the issue and respond more quickly than we can via phone. Plus, it’s fast and easy for you! Here’s how to submit an inquiry on CONNECT:

New CONNECT users need to work with the medical group or clinic administrator in their office or clinic to get a CONNECT username and password.

Once the medical group or clinic administrator has set up your account and provided you with your temporary login information, a verification link will be sent to your email address.

Once you click the email verification link, your user account is verified and you’re registered for CONNECT.

To login to the system for the first time, use the temporary username and password given to you by your medical group or clinic administrator.

Once you are logged in, you can change your user account information (user name, password, email address, etc.) by going to the “User Settings” tab located in the top left hand corner of your dashboard screen. In fact, in compliance with HIPAA regulations, you will be required to change your password every 90 days.

What should I do if I have questions about using CONNECT?

Once you login, you can submit inquiries and questions through the system. By submitting your inquiries online, we can investigate the issue and respond more quickly than we can via phone.

I am a primary care physician. What procedures require an authorization and what can I do without an authorization?

Primary care physician contracts specifically list those services that may be performed by a PCP without an authorization. Anything that is not outlined in the contract — whether performed by a PCP in the office or by any other specialty physician or ancillary service outside of the office — will require an authorization. If a PCP wishes to perform a specific, in-office service that is not listed in the contract, they can submit a letter to our EHS Utilization Management Committee for consideration. Our UM medical directors will review the request and make a decision based on medical appropriateness. EHS is committed to streamlining the referral process. Our proprietary “care excellence” models ensure alignment with evidence-based medicine guidelines, while exceeding the turnaround times established by regulatory standards. In many cases, authorizations are approved almost immediately after they are submitted. This allows you to print the authorization and provide it to the patient before they leave your office.

I submitted my claim several weeks ago. When will I get paid?

Regardless of the method by which EHS receives your clean claim (a correctly completed claim), state law allows 30 calendar days for claim processing. However, it may not take a full 30 days to process your claim. Check runs are generated weekly, and providers and physician offices may check the status of their claims on CONNECT.